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CONGRESS PASSES LAW ABOLISHING MANDATORY MEDICARE X-RAY REQUIREMENT -- ACA SCORES MULTIPLE VICTORIES AS OTHER PROVIDERS TAKE HITS IN HISTORIC BUDGET BILL

Congressional Budget Office Says Elimination of X-Ray Barrier to Increase Chiropractic Reimbursement $2 Billion Over Ten Years

ACA-Supported Provider Anti-Discrimination Clause Included in Final Bill; Provision Aimed at Medicare HMO Abuses

Managed Care Industry Fails in Effort to Expand ERISA and Further Preempt State Provider Protection Laws

WASHINGTON, D.C. -- The U.S. Congress today passed a historic legislative agreement which seeks to reduce the federal deficit, provide tax relief for millions of Americans, and preserve the solvency of the Medicare program into the next century. Included in the sweeping legislation, known as the Balanced Budget Act of 1997, are a number of ACA-supported provisions which benefit the chiropractic profession -- including the elimination of a provision of current law which requires that x-rays be taken before chiropractors can provide spinal manipulation benefits to Medicare beneficiaries. Another key provision seeks to bar Medicare managed care plans from discriminating against the participation of providers in their health plans, based solely on the type or scope of the provider's license.

Regarding these historic legislative victories, ACA President Dr. Michael D. Pedigo said, "The key provisions we won represent a major step toward ending discrimination against doctors of chiropractic in Medicare. These important improvements are the result of one thing -- years of persistent lobbying efforts by the ACA and ACA-PAC.

A description of key issues contained in the Balanced Budget Act which are most relevant to the chiropractic profession are listed below:

Abolishment of Medicare X-ray Barrier

Following failed efforts in the last Congress to reach agreement on cutting billions of dollars out of the Medicare program, Congressional leaders and the Clinton White House reached agreement on a series of Medicare reforms which are projected to save the federal treasury about $115 billion over the next five years. These reforms, which reduce payments to hospitals, nursing homes and other providers, were incorporated in the legislation which Congress passed today.

Also incorporated in the final bill is a provision of President Clinton's original budget proposal, which would eliminate the mandatory x-ray requirement for access to chiropractic services under Medicare. The provision is similar to stand-alone legislation introduced earlier in the year, at ACA's request, by Rep. Phil Crane (R-Illinois) and Senate Minority Leader Tom Daschle (D-South Dakota). The new provision of law removes an intentional barrier to chiropractic care, placed in Medicare law over twenty years ago by the "medical lobby" during the height of the American Medical Association-led boycott of the chiropractic profession. Under terms of the Balanced Budget Act, the new provision abolishing the mandatory x-ray would become effective January l, 2000.

Winning approval for the provision was a difficult, uphill battle -- and ACA lobbyists were unsure the provision would be approved until late in the negotiation process over the final contents of the legislation in late July. The long process of approval received its first critical boost earlier this year when President Clinton, after a year-long lobbying effort by the ACA, agreed to include the proposal as part of his formal budget recommendation to Congress. At that time, White House budget estimators projected the five-year cost of the proposal would be $200 million, because of increased "induced demand" for chiropractic spinal manipulation services.

Fearing these "high costs" would doom the proposal in a GOP-controlled Congress determined to cut billions of dollars from the cost of the Medicare program, the ACA quickly lined up the support of Rep. Phil Crane, a prominent Republican member of the House Ways & Means Committee which has jurisdiction over Medicare, to introduce a stand-alone bill (H.R. 916) identical to the President's proposal. Crane's support was critical, because his active and highly visible efforts on behalf of H.R. 916 helped build crucial support for the proposal in the GOP-dominated Congress.

A near-fatal blow, however, occurred in the spring of this year, when the Congressional Budget Office (CBO) released an official estimate projecting that the five-year cost of the proposal would be $900 million -- over triple the White House cost estimates. Because of the staggering cost implications, many at that time believed the proposal would fail; however, due to continued grassroots lobbying and the steadfast support of Representative Crane and ACA's other Capitol Hill allies, the proposal was successfully incorporated in the House Ways & Means Committee version of the Balanced Budget Act in early June. Following the crucial Ways & Means Committee action, the House Commerce Committee, with the forceful backing of influential Republican member Dennis Hastert (R-Illinois), also included the proposal in their version of the bill -- effectively paving the way for full House approval of the provision in late June.

Prospects in the U.S. Senate were considerably bleaker, where the proposal was vigorously opposed by key members of the Senate Finance Committee staff. Because of this opposition and the controversy over the proposal's cost, it was not included in the Senate version of the Budget Bill. However, with the aggressive support of Sen. Orrin Hatch (R-Utah) and Sen. Charles Grassley (R-Iowa) the Senate "conferees" were convinced to accept the House provision -- even though CBO ultimately pegged the ten-year cost of the proposal at over $2 billion.

At the request of the ACA, the House and Senate conferees also inserted language into the official Conference Report describing the bill, which states: "Nothing in this section shall be interpreted as a legislative indication that x-ray findings are not important and can serve a purpose in the practice of chiropractic." According to previous statements by senior Health Care Financing Administration (HCFA) official Barbara Wynn, the agency is expected to continue reimbursement for x-rays taken on the referral of a chiropractor, when considered medically necessary. HCFA is expected to work closely with the ACA to determine appropriate criteria for the identification of subluxations in those cases where x-rays are not taken.

ACA Wins Anti-Discrimination Provision In Medicare Managed Care Plans

In a setback to the managed care industry, as well as certain elements of organized medicine, the House and Senate conferees accepted a Senate provision that prohibits provider discrimination by Medicare managed care plans, based solely on the license of the individual provider. This provision, supported by an ACA-led coalition of non-M.D. provider groups, is similar to a provision contained in the ACA-backed Patient Access to Responsible Care Act (PARCA bill), sponsored by U.S. Rep. Charles Norwood (R-GA) and Sen. Alfonse D'Amato (R-NY). According to the ACA and other groups supporting the anti-discrimination provision, winning Congressional support for the principle that providers, such as chiropractors, should not be discriminated against because of their license, is a key victory which is expected to have both practical and symbolic value in dealing with managed care and other insurance plans.

Defeat of Managed Care ERISA Expansion

The final bill eliminated a House provision which would have allowed small businesses and individuals to obtain health insurance through a mechanism circumventing state regulatory authority and expanding the troublesome Employee Retirement Income Security Act (ERISA) preemption. Known as Multiple Employer Welfare Arrangements (MEWAs), these provisions would have further eroded the effectiveness of state any-willing-provider, insurance equality and similar anti-managed care laws. The MEWA provisions were vigorously opposed by the ACA and other groups -- but strongly supported by the U.S. Chamber of Commerce and the National Federation of Independent Business.

Managed Care Gag Rules Abolished

The final legislation contains a provision which prohibits any interference with open communication between a doctor and his or her patient in a managed care environment. This provision, strongly supported by the ACA and a key provision in the PARCA bill, would eliminate one of the major abuses in managed care by insuring that patients have access to easily understandable information about their health care policies, particularly coverage details and the plan's history of patient satisfaction.

Medical Lobby Fails to Kill Medicare Practice Expense Overhaul Beneficial to Chiropractic

Efforts to "kill off" a planned overhaul of the practice expense component of the Medicare fee schedule which would be beneficial to chiropractors and other non-hospital based providers failed. After prolonged negotiation, Congress agreed to a one year delay and a three-year phase-in of the new practice expense reimbursement rates. Full implementation of the new fee schedule component is estimated to ultimately add as much as 15% to overall chiropractic reimbursement in the Medicare program. These particular increases are estimated to ultimately top the significant increases ACA won in the "work value" portion of the fee schedule in late 1996.

Medical Savings Accounts Expand Patient Choice of Provider In Medicare

Conferees agreed to include the House version of the Medical Savings Account (MSA) demonstration project, which will include 500,000 Medicare participants. Under this provision, individuals eligible for Medicare would be permitted to choose either the traditional Medicare program or a Medicare/Plus MSA plan. In general, a Medicare/Plus MSA would be a tax-exempt trust (or a custodial account) created exclusively for the purpose of paying for qualified medical expenses. The ACA strongly supported this provision since it will increase individuals' access to chiropractic care.

Chiropractic Gains Are Stark Contrast to Other Provider Losses

While the chiropractic profession won gains calculated in the hundreds of millions of dollars, most other provider groups, including physical therapists, hospitals, nursing homes and medical equipment suppliers took sizable hits in their reimbursement under Medicare.

Aggressive Initiatives -- Including Legal Action Planned